What Ted Cruz doesn't get about dying with dignity

My patients need to understand their options and make their own decisions

The "End-of-Life Conveyor Belt": Dying patients are kept alive by
machines, alone in a cold and sterile environment, their arms strapped
down to the bed so that their catheters aren't dislodged.

Photo: Getty Images, Jan Halaska

Elderly and seriously ill patients are at risk due to the misguided thinking of two Republican lawmakers. Senator Ted Cruz of Texas suggests that palliative care shortens the lives of elders. And a bill, HR 410, from Iowa Rep. Steve King aims to prevent Medicare from paying physicians to speak with their patients about end-of-life medical preferences. Both men are challenging practices that inform patients about their illnesses and treatment options.

As an ICU physician, I witness every day the effects that poor access to information has on vulnerable patients. My ICU training programmed me to treat everyone, the strong and the weak, the old and the young, the fit and the terminally ill, in the exact same way: with the most aggressive, life-prolonging tools we had to offer. But over the past two decades of practice, I have learned that this approach inflicts unnecessary suffering on too many of my patients — specifically those with terminal illness, dementia or old age.

It is marvelous when our prolong-life-at-all-costs paradigm enables us to save our patients. But for patients with serious illness or frailty, this approach too often leads to a phenomenon I call the End-of-Life Conveyor Belt. Here, dying patients are kept alive by machines, alone in a cold and sterile environment, their arms strapped down to the bed so that their catheters aren't dislodged.

Many people prefer palliative care and making the most of the life that remains to them. (Here: Pet therapy at Houston Hospice.)

Photo: Lehane Richards

This is not what people want. Data show that patients who are informed by their doctors about the options available at the end of life both live and die better. They choose to use far less technology, suffer less pain, and enjoy significantly improved quality of life before dying.

Our society is awakening to the public health crisis that is the state of dying in America. And we are beginning to address it.

Two important examples are the rise of the palliative-care movement, which aims to enhance communication between the healthcare team and patients; and the 2016 decision by Medicare to begin compensating physicians to discuss the range of options available to patients at the ends of their lives.

Both of these are now under attack by Cruz and King.

Palliative-care consultations and enhanced communication between patient and physician translate into more choice, better lives, and significantly less governmental spending. This seems like something most Republicans would support. Do these politicians understand what they are arguing for?

Representative King's bill, ironically titled "Protecting Life Until Natural Death Act," was recently referred to the House Subcommittee on Health. The choice of the bill's title indicates that King feels that access to information is somehow endangering patients' lives.

Writer Dr. Jessica Zitter confronts the most difficult of decisions with patients and their families every day. (From "Extremis," nominated for best documentary-short subject at this year's Oscars.)

Photo: Courtesy Dan Krauss

Senator Cruz recently expressed his disdain for palliative care on CNN. He warned that if America doesn't get rid of Obamacare, we would become like European healthcare systems where the elderly "are often put in palliative care, essentially doped up with some drugs, and said, 'Well, now is your time to go.'"

He argued that full ICU care for the sick elderly was instead the right approach. This statement betrays Senator Cruz's ignorance on the topic: ICU and palliative care are not mutually exclusive. And his suggestion that ICU care will always prolong life, even for the sick and elderly, is simply wrong.

Both these men are essentially arguing against patients' right to receive information about their medical conditions and make their own choices. In a cruel irony, these champions of government non-interference are themselves dictating how patients should die.

As a physician on the front lines of this work, I am alarmed by these politicians' perspectives. Those of us who value autonomy must call on Congress to defeat HR 410. We must inform politicians like Ted Cruz that the goal of palliative care is personal empowerment and control. And maybe Cruz and King should join me on my rounds to learn more about these issues they feel so strongly about.

Jessica Nutik Zitter, MD, MPH, author of Extreme Measures: Finding a Better Path to the End of Life, specializes in critical care and palliative care medicine. Featured in the Academy Award-nominated 2016 Netflix documentary Extremis, she is a graduate of Stanford University and Case Western Reserve Medical School, and completed her residency in internal medicine at the Brigham and Women's Hospital (Harvard Medical School). She was a fellow in pulmonary and critical care medicine at UCSF, and earned a master's in Public Health from UC Berkeley.